Depression: Causes (Chapter 3)

Depression has two basic causes: those outside us, and those inside us. Within these two categories, there are several other, more specific, causes.

On the outside
1. Stress
Stress can come in one fell swoop, in a single event, such as rape or robbery, or in a set of circumstances, such as a soldier in the Vietnam War: the guerrilla tactics used in this combat overstretched soldiers’ concentration, straining their biological and mental resources farther than people are meant to bear.

Stress can also be several less major events over a period of time, and their effects combine to push us down. The sort of events that cause stress could be anything, from losing a loved one to losing our job, from moving house to divorce. On average, three of these events within a year are enough to cause depression[1].

marriage death of spouse
moving house divorce
birth of child death of child
bankruptcy death of other family member
interview court case
sickness surgery
imprisonment loss of limb
loss of sense loss of job

Or the stressor might something that happens every day: an aggravating boss or co-worker; parents or teachers continually telling us we’re stupid or useless. Day by day, these little weights will start to crush us, until we can’t cope with the demands of everyday life.

Stress can cause depression in this way. Imagine a taut wire. A weight is hung on it, heavier than the wire was meant to bear. The weight will stretch the wire, with the result that when the weight is removed, the wire will hang down, no longer taut. It has lost its resilience, and can’t support the load it was designed for. This is what trauma can do to us: it can drag us down until we’re overstrung, and can’t carry loads that we otherwise could.

However, stress doesn’t necessarily lead to depression. It depends partly on the severity of the events, but chiefly how we respond to them. We can be protected from depression by people (family and friends), activities (sport and hobbies) or a religious faith. Nonetheless, the essential cause of depression — the change in our biochemistry — often results from the build-up of stressful events [2].

2. Environment
In the case of Seasonal Affective Disorder, the main cause of depression seems to be a lack of sunlight. The connection between darkness and depression may be the pineal gland. Located in the brain, the pineal gland produces the chemical melatonin, which helps us sleep (And as we saw earlier, serotonin helps to regulate sleep). Melatonin is produced at night, so when the night is longer, it produces more melatonin [3]. The pineal gland also produces other neurotransmitters that relate to depression, such as serotonin and noradrenaline [4]. A low level of serotonin is one of the causes of depression: so perhaps when the pineal gland is producing more melatonin, it doesn’t have time to produce as much serotonin, because the same amino acid, tryptophan, is used to manufacture both serotonin and melatonin [5]. QED?

Religious bit. Christians and depression
“There are more things in heaven and earth … than are dreamt of in your philosophy.”
Hamlet, Act what Scene what.

It seems that Christians especially are prone to depression (or maybe it’s just my evangelical coterie!). Some Christians believe that, if a Christian has depression, it’s because we lack the faith to be healed, or we’re being punished for our sin or we’re oppressed by demons. Whatever causes depression has, there is no sound reason to discount the supernatural. I’m not saying there is a supernatural cause behind every illness — the Bible does distinguish sickness and demonic activity — but such a cause might play a part in our depression. Let’s see how these three “Christian” possibilities could interact with depression.

a. Lack of faith.
As for the accusation that we don’t have enough faith … If we trust in Jesus, that is enough. What matters is who we have faith in: Messiah Jesus, God the living Word, who died in our place, was resurrected to eternal life and rule, and saves all who trust Him. This cannot be over-emphasised: what matters is that you have faith in Jesus, not how strong your faith is. (I’ve looked at this issue in more depth in chapter 5.)

b. Divine punishment.
Could depression be a punishment for sin? Simply, no; here’s why. Firstly, punishment looks backward, and is a payment for what we’ve done wrong. Discipline looks forward, and is preparing us to face life as beloved children of God. Secondly, on the cross, Jesus took God’s punishment for our sins, past, present and future. “Therefore there is now no condemnation” (Romans 8). If we aren’t condemned, we can’t be punished.

Depression isn’t punishment, but it may be discipline: preparation and training to live a godly life. In any case, treat your depression that way:

“My son, do not make light of the Lord’s discipline,
and do not lose heart when he rebukes you,
because the Lord disciplines those he loves,
and he punishes everyone he accepts as a son.”

Endure hardship as discipline; God is treating you as sons. For what son is not disciplined by his father? … God disciplines us for our good, that we may share in his holiness. No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it. [6]

c. Demonic oppression.
What if a Christian has been “delivered” from demonic depression, and yet continues to experience symptoms of the illness? It is probably wrong to assert that their problem is only supernatural, but it is certainly wrong to say that they didn’t have enough faith. This explanation ignores that depression usually has natural (biological, emotional and mental) causes. If we aren’t healed through deliverance, then these natural causes must be considered, even if they are less impressive than a demon.

However, there’s no need to assert “demon” when “biology” can fully explain the symptoms; for the Fall also made us vulnerable to sickness and decay. Nonetheless, if common causes are ruled out, then uncommon ones should be considered, no matter how unlikely we think they are [7].

There are other reasons that people with a religious faith might suffer from depression. In any group of more than two people, at least one member will be segregated in some way. And religious groups are little different: many of them — even the most egalitarian — develop a hierarchy. In countries where the Islamic shariah [8] is the rule of law, women are regarded as secondary citizens. Again, even today, some people believe that God cursed people with black skin to be slaves [9].

In churches where the Bible is the guide of faith, people who appear more gifted tend to be given more respect; despite passages like 1 Corinthians 12-14. (Everyone in the Body of Christ is equally necessary, although we have different roles.) Almost every religion has a system of ethics and behaviour that members have to keep, at the risk of condemnation and exclusion. The fear of this dominates your life. Living this way for any amount of time, believing you are constantly under God’s critical and merciless gaze (although it’s that of the organisation), can lead to frustration, resentment, anxiety and depression.

On the inside.
This section looks at how our biology, mind, and emotions, as well as our lifestyle could make us vulnerable to depression.

1. Biology
Biochemistry [10]
There are several chemicals involved in depression, such as serotonin and noradrenaline [11]. Serotonin regulates our sleep and keeps us emotionally stable. When it’s low, our emotions fluctuate easily. For example, when we’re in love, our level of serotonin decreases. But for the person with depression, the chemicals that give us a positive emotional charge are also low, and we feel miserable.

Chemical imbalances can cause depression in women who have just given birth (post-partum depression [12]). It’s hardly astonishing, with the changes their bodies have been through during the last nine months. There are other biochemical changes and conditions that can cause depression: hypothyroidism can even be mistaken for depression.
Genes
Some people are likely to have depression because of their genetic blueprint. As I write this, it’s less than a week ago that the discovery of that genetic factor was announced: the Short Serotonin Transporter Gene. Almost half the population (43%) have this gene [13]. Whether this gene is activated or not depends less on what happens to us than how we cope. If we face life realistically but with optimism, we’re less likely to develop depression.

Our personality is where our biology, mind and emotions meet. While we are influenced by both our genes and our upbringing, it’s difficult to know which has the greater influence [14]. Some theories say that we are a blank slate, waiting for the world to write on us [15]. On the other hand, all the parents I know think that each of their children has their own personality from birth.

As we grow up, we learn acceptable and unacceptable behaviour. We’re told: “stand up for yourself”; “the squeaky wheel gets the grease”, and so on. (I learned that I should keep my mouth shut because much of what I said was foolish: either inane or stupid.) We learn who has power over us, and whom we have power over. We learn that most people value us because of what we can do for them. We find activities that we are good at, that we like doing, and others that we’re not good at. Some people like us, some people don’t, and we may not know why. We have desires that aren’t always met.

We respond to all of these experiences: each of us deals with our weaknesses, fears and disappointments in ways different from those of other people. One person faces the situation stoically; another tries to avoid the conflict entirely; a third refuses to believe there is a problem at all; yet another person finds themselves completely unable to cope, and becomes ill. There are many attitudes we can take to any situation, and what we choose to do depends on our personality.

The best way to deal with a problem is directly. If we refuse to face a problem, we will start to experience emotional unrest. So we develop “coping mechanisms” to help us avoid conflict. Think of these coping mechanisms as kinks in our emotional water-hose. They try to stop the muddy water of conflict from reaching the garden bed of our consciousness: if it does, we will have to deal with it, and that will be uncomfortable for us. The person who deals with the situation directly will have a straighter, healthier, happier hose than the person who ties knots in themselves, trying to avoid the situation, or make it less painful. The more kinks there are in our emotional hose, the more likely we are to suffer from an illness like depression. The illness may be our psyche’s way of telling us “You have issues to deal with!”

Personality types
There are various ways psychologists have classified personalities. One of the most enduring is the Hippocrates-Galen classification: melancholy, phlegmatic, choleric and sanguine [16].

The melancholic is the deep thinker, able to see a situation from many perspectives. The sanguine thinks, “What a party-killer”, and avoids them: they don’t like to be around people who bring them down. The choleric snaps, “Pull yourself out of it!” The phlegmatic says, “Dude, you’re too intense; just let it go. Chill.”

All the personality types have their strengths and weaknesses. Depression is one of the experiences that a melancholic personality is prone to. We have a major personality type: we may also have a minor one. For example, a choleric melancholic (mostly melancholy, with a choleric minor) is more likely to try whatever they can to get out of the rut of depression. A phlegmatic melancholic thinks a lot, but couldn’t be bothered doing anything about it.

I’ve dealt with anger by itself, for this reason: depression has been described as “anger turned inwards”. This is why. As we saw in the previous section, a person’s personality will enable them to deal with conflict in different ways. It isn’t just the conflict we have to deal with, though; there are also the emotions that the conflict stirs up, such as anger. And especially when we feel powerless, anger is a natural response to conflict. But because we feel powerless against a stronger opponent, we choose to suppress our anger.

In chapter one, I spoke about the fallacy that depression is a result of emotional weakness. The usual advice accompanying that diagnosis is to keep our emotions on a tight rein: “stiff upper lip, old bean.” But this isn’t strength; it’s suppression. People suppress their emotions to show that they are in control. But suppressing emotions — particularly anger — makes depression worse. Here’s why.

Maybe we’ve been told it’s not nice to get angry. Maybe we’re afraid of making things worse if we tell them how we’re feeling. However, we don’t feel secure enough in our relationship with the other person to express our anger, so we hold back, not saying anything, “playing nice.”

If the person making you angry is essentially equal to you — in status, work, ability and so on — it’s easier to express your feelings. Or you can vent to someone higher up the food chain. But when it’s that person, one who holds authority over us, who is the source of the aggravation, it’s tougher to deal with: they could fire us or make our life unpleasant in other ways. The more dependent we are on them, the greater potential they have to aggravate us. This is bad enough, but it is especially nasty if they use a technique called the double bind.

Heads you win, tails I lose: caught in the double bind.
Perhaps we were bullied at school, and our parents told us “Stand up for yourself!” So we do. Maybe it worked in the school yard. But then comes a time when our parents say or do something we don’t like, and we stand up to them. But instead of commending us for doing what they told us to do, they tell us “Don’t backchat”, or “If you don’t like it, there’s the front door.” We stood up for ourselves just like they told us; but they quashed us [18].

This is the double bind, the no-win situation. You’re damned if you do and damned if you don’t. We become angry at this double standard, but we tell ourselves that there’s no point in complaining; it will only make matters worse [19]. We can’t express our anger at the person, so we suppress it. The double bind can create anger that is almost designed for suppression. Since the anger has no place to go, it starts to eat away at us. We silently fume at the other person, and maybe also at ourselves, for letting them get away with the injustice. If we don’t express our anger in some way, it’s at this stage that it turns to bite us. We start to hurl mental abuse at ourselves: “you stupid git, you never do anything right; no wonder you’ve got no real friends; who’d want to hang around with a dumb, useless waste of space like you.”

The festering anger that fosters depression is an anger that is personal. It is focussed on a specific person because of their treatment of us. It isn’t anger born of injustice or of the suffering of distant people, such as the Tsutsi genocide by the Hutus in Rwanda. It may make us feel angry and helpless, but we don’t take it as a personal attack. We don’t ascribe it to ourselves as a personal failure.

We need to acknowledge and express our emotions. They are a part of who we are; they reflect what we think of ourselves and other people. They reflect our values, the things we think are important and good. (It doesn’t mean they are, merely that we believe it.) When those treasures are threatened, we become angry or afraid. If we suppress those warning emotions, we’re pretending that the things we treasure aren’t really important. We’re denying what matters to us, which boil down to two essential needs that all people have.

Two essential needs
All people have two essential needs that must be met to keep us emotionally healthy. These needs are:
to be loved and accepted unconditionally; and
to be significant, to make a difference [20].

To be loved
We need to believe that at least one person accepts us as we are, warts and all. It gives us emotional strength to cope with the uncertainties of life. The problem is that we believe love depends on performance, on how good we are. From our earliest days, one of the lessons we learn is that we’re only as valuable as what we do. We learn that our parents are happy with us when we’re good and unhappy with us when we’re bad. (Heaven forfend that “good” and “bad” may be more related to our parents’ convenience than to morality.) Later, at school, we’re taking tests and getting marked on how well we do. When we get high marks, our teachers and parents show approval.

The pattern is repeated through life. When we do well, people approve of us. On the other hand, when we do poorly, people look down on us … and Polly don’t like that cracker. So Polly decides to do the best he can to get other people’s approval. We have come to believe that we are only accepted if we do well. We measure our value by our achievements.

There are some activities we like doing, and we’re good at; better than other people are. We also notice that, no matter how much we try, others are better than we are at some activities. As we seek approval and acceptance by doing well, we try to find an activity where we can be better than everyone else.

Unfortunately, not many of us realise that while doing something useful is important — both for society and for our self-esteem — if we confuse what we do with who we are, then, when we are no longer able to do what we used to, our self-esteem will be destroyed. We recognise this mistake when we come home from work — to an empty flat (house et cetera). This is a metaphor for our life: when we cannot do, and can only be, will we have someone to be with us? When our usefulness is finished, when we have nothing more to offer, will anyone be waiting for us, will anyone love us, despite this?

Pray that you can answer “yes.”

To be significant
No-one can bear the knowledge that they are not needed [21].
~ Dr James Dobson

When we meet a person for the first time, the first thing we learn is their name. The second question we ask is “What do you do for a living?” We learn that some jobs get more money and respect than others [22]. The person who mends our fat-bloated arteries gets more of both than the person who mends our roads. The TV personality gets more than the abuse counsellor.

Immortality has long been a human desire. People have in ancient cultures sought it in two ways. They knew they wouldn’t live forever, so they wanted people to remember them for what they did [23]. For royalty or the rich, it could have been by building; such as the pyramids in Egypt. Shelley’s poem Ozymandias reflects what a doubtful means this is.

… Two vast and trunkless legs of stone
Stand in the desert. Near them, on the sand,
Half sunk, a shattered visage lies …
And on the pedestal these words appear:
‘I am Ozymandias, king of kings;
Look on my works, ye Mighty, and despair!’
Nothing beside remains. Round the decay …
The lone and level sands stretch far away. [24]

Others, without the means to build in stone, sought glory through battle. The Iliad is a classic epic poem about the Trojan War, and honoured those who fought and died in that conflict. About 3,000 years later, a British military action during the Crimean War provided the inspiration for Tennyson’s archetypal glory-of-battle poem, “The Charge of the Light Brigade.” It commemorated the bravery of the 17th Lancers in an almost-suicidal attack [25]. Whether it was meant to glorify war is another matter. In any case, fighting and dying in battle has long been seen as a way to be remembered.

However, being remembered by a lot of people isn’t the same thing as being significant. Of course, people such as Jesus, Gandhi, Mother Teresa, Mohammed and Lincoln are remembered for what they did. So are Amin, Stalin, Herod the Great, and the Roman emperor Nero. But most of us won’t attain their fame (or notoriety).

Certainly fame is fleeting. For example: who won Oscars for “Best Actor” in the last five years? Which teams won their sport’s highest national honour in that same time? Now, on the other hand, name five people who have encouraged you, five people who have helped you to see things in a different light; five people who have laughed with you.

From these answers, I hope you can see that, ultimately, fame is impersonal: our name is known, but we may have little real impact on people’s lives. On the other hand, significance is personal: it affects our lives, not only how we live, but also whether we live. We are significant to the people we meet everyday: family, friends, work colleagues, the checkout chick or chuck. Our significance comes from how we, personally, affect them; for good or bad.

Unmet needs
What happens if these two needs of ours aren’t met? We can’t make anyone love us, and we aren’t really good at anything. So how can we be significant? Simply, our path will inevitably lead to destruction — of ourselves, others, or both.

If we create something, maybe no-one will care. But if we destroy something, someone definitely will! Destruction is a quick and easy way to matter. Think about the Force in Star Wars: the Dark Side is called “the easy way” because destruction is easy. Anyone — toddlers, even babies — can curl their fingers into a fist and strike out at something. If we destroy something, we’ll make a difference. People may hate and fear us, but at least we’ll matter.

The idea of hurting people makes us feel powerful. The anger buoys us, because we know we can make a difference. The satisfaction we feel is not so much the desire to inflict pain: it’s the knowledge that we have the power to affect someone. And if we can affect someone, we do matter.

But what if we know that we won’t, or can’t, turn those thoughts into reality? It’s similar to the double bind: we feel angry, but we suppress it — and become depressed [26].

3. Mind
The third kind of internal cause of depression is how we think: this includes how we respond to other people. Our mind is the most important factor in overcoming depression. It interacts with our brain, personality, emotions and health. For example, it’s difficult to think happy thoughts when we’re sick or sad, but if we are healthy and cheerful we can resist depressive thoughts quite easily.

This relationship between our minds and bodies also works the other way: if we choose to look at the bright side of life, we will begin to develop a more optimistic personality. Having said this, one negative comment needs ten positive ones to balance it out [27]. In a culture where we have become cynical about other people’s good will and motives, where the media emphasises bad news over good, where it’s easier to offer sarcasm than constructive feedback, the mental seeds of depression have abundant fertiliser to help them grow.

In Agatha Christie’s The ABC Murders, Hercule Poirot noted that there is logic to everyone’s thoughts, even if their logic seems bizarre to the rest of us. The logic of the person with depression is irrational: how we think is controlled by how we feel, not the other way around. We can recognise this (usually once someone points it out), but the battle to regain control of our thoughts is a hard-fought and tiring one — but if we keep fighting we will win; that is a certainty. To help us before we start throwing punches, let’s see the two strategic mental areas we want to control: what we believe, and what we focus on.
a. What we believe
Our minds have immense power over our bodies. If we have an unpleasant appointment, we might unconsciously make ourselves sick to avoid it. This is called a psychosomatic illness: the mind runs the body off the rails. The original Australians have a ritual called “pointing the bone”. If you wanted to curse someone, you would point a kangaroo bone at them. A short time later, they would die. There would be no physical cause for it, like snakebite or poisoned food. The victim would simply believe that they were going to die. Nothing could convince them otherwise; so they died. Depression is not a psychosomatic illness: that is, it doesn’t directly make us physically ill. Nevertheless, our beliefs and attitudes affect depression — and vice versa — more than any other illness.

What happens when what we believe clashes with what we experience? Which gives way? Do we abandon our beliefs, or modify them? Or do we try to explain away our experience? Or do we keep the two in separate compartments of our lives, so that they never meet? These are some of the issues in understanding the mental causes of depression. And as there are two mental aspects to depression, there are two types of belief that affect how we think. We hold beliefs about the world, and about ourselves and others.

i. Beliefs about the world
We hold beliefs about life and the universe: what it is, how it came to be, why we are here, where we are going — the meaning of it all. We want to know, Is the world a safe place? a good place? These beliefs and questions are the domain of religion and philosophy. Whatever we believe affects our depression: it can make it worse or better; but this still depends on us as individuals. For example, if we don’t believe there’s any afterlife, that there’s no judgement, we might feel free from the fear of judgement. Or we might feel miserable because we believe that life is unfair and has no objective meaning. Again, if we believe that there is a God in control of everything, we can be happy because we believe (rightly or wrongly) that, eventually, justice will be done, and there is hope for a better life. Or we may despair because we’re afraid of being condemned in the afterlife.

This latter fear was true for me, and contributed to my depression [28]. If I could have believed what I wanted, I would have chosen atheism. If there was no judgement after death, there would be no need to be good. We could live how we wanted; every man for himself. (Yes, “man”. No need to care about gender equality or political correctness!) He who dies with the most toys wins. If there’s no God, there’s no absolute right or wrong. And if you didn’t like your life, you could just pack it in. But what I believe usually rides over what I want, and tramples it in the process.

Another part of our worldview involves ethics and morality: right and wrong belief and behaviour. One ethical issue concerns means and ends: specifically, does the end justify the means? Is it okay to lie to save a life? Is it okay — is it possible — to build a peaceful and just society on the back of violent and bloody revolution? Consider the French Revolution or the English Civil War.

And what about these sayings: “Might makes right.” [29] Or the cynic’s Golden Rule: “whoever has the gold makes the rules.” They imply that even if there is true justice, the only kind we can expect to see depends on those stronger than us. Parents and teachers have this power —physical, mental and emotional — over the children under their care. If they use this power to selfishly dominate everything in a child’s world, that child will grow up feeling powerless. The same is true of people who hold high legal offices; police, judiciary, politicians should be just.

When we feel powerless to change anything, we feel hopeless. And without hope, we die. Not physically, but our desire to improve ourselves or our situation. When hope dies, so do our joy and our desire [30]. If we’re living on a false hope, this can be a good thing, because only then can we move on. But there are some things it is good to desire: peace, enlightenment, and relationships. When hope for these is killed — and hope can take a lot of punishment — we become little more than walking corpses.

ii. Beliefs about ourselves and others
Our worldview also encompasses what we believe about ourselves and other people. To begin with, how did life come about? (This is parallel, but not identical, to our beliefs about the meaning of life.) Are people a cosmic accident, or were we created by divine fiat? If the former, can we believe that anything, finally, matters? If we care about anything beyond ourselves, it should be the survival of the human race [31]. In that case, we have no value beyond what we give to society.

It is a utilitarian creed: if we can’t contribute, we have neither reason nor right to exist. But, logically, it would be the highest creed for us to ascribe to. For humanity to survive as long as possible, we have to make people as perfect as we can. This was part of the philosophy of Friedrich Nietzsche, which was taken up by the National Socialist Party (the Nazis), who considered that they, the Germans, were the world’s master race.

If this is what you believed, and you knew you didn’t meet society’s ideal — if you were Jewish, black, Communist, Slavic, malformed, weak or ill — you would be a ready prey for depression.

The other possibility for our genesis is that we were created. This wouldn’t necessarily mean we have an intrinsic value, though, it would depend on who or what created us. We might only be as valuable as we fulfil our purpose. This belief could help depression grind us down. For example, in most ancient near eastern societies, people were told that they were created only to provide food for the gods, who couldn’t be bothered to do it themselves. (The gods were represented by the royal house and the nobility, so they had a vested interest in maintaining the status quo.) This wouldn’t have done a lot for a person’s self-worth.

Or we might find that our worth doesn’t depend on what we do, but rather that all people are created equal and priceless. This knowledge could be a strong buffer against depression. The example of this is found in the first two chapters of Genesis. People were created in the image as God’s representatives, to rule the earth as His regents.

These hypotheses are the opposite ends of the range of possibilities. Determining which one is most probable is an issue for faith. But you get the point: if we believe that we are valuable just because we exist, it follows that we are less likely to experience depression. Maybe you’ve never thought about all this, so it hasn’t been an issue for you. If not, odds are that you will meet someone whom it is an issue for. Teenagers for example; people facing retirement or another major change in their lives.

If you thought the situation was complex already, there’s something else to throw into the mix. In general, consistency is not a strong human attribute. We don’t always act in line with what we say we believe. We give mental assent to one view, but in practice live out another. We might believe we are biological accidents, and only the strongest should survive; yet hearing news about a famine in Burkina Faso, we feel compassion for those people, who we have never met. We might donate money to help them, perhaps even at some inconvenience to ourselves. On the other hand, we might say we believe that people are created in the image of God; yet we gossip about other people and belittle them behind their backs. Why this inconsistency?

Two kinds of belief
These inconsistencies occur because we have two types of belief. One is intellectual, the other is emotional. For the person with depression, the grey that colours our world is emotional. When we muffle our emotions so we can hear our mind, we realise that much of our grey worldview is irrational: it is based on how we feel. Beliefs based on emotions aren’t rational: they don’t make much sense, nor reflect reality [32].

So we can believe that all people are of equal value simply because they exist, but at the same time tell ourselves that we are a useless, toxic lump of malodorous biological effluent, and the world would be better without us. We can appreciate how a smile could brighten someone else’s day, but think that our work as a teacher or surgeon is worthless. Not the work itself, note, but our work. If we didn’t exist, someone else would have done our job, and done it much better than we do.

You see the difference between intellectual and emotional belief? If our life is a play, then depression brings our emotional, irrational beliefs to centre stage and turns the volume to maximum. At the same time, it lowers the curtain on our mind and takes away its microphone. When this happens, we only hear the banshee wail of our misery.

So what are these emotional beliefs that depression can get a hold on? Thinking about ourselves and others respectively, the mental grips for depression are our self-esteem and our expectations.

i. Self-esteem
“I’m tired of being treated like dirt! I’m better than dirt … well, not that store-bought dirt, though; that stuff’s full of nutrients. I can’t compete with that.”
~ Moe Syzslak, The Simpsons.

Self-esteem is what we think of ourselves. It is based on whether we believe that we are loved and significant. We can discover what matters more to us personally — significance or acceptance — through mirror listening: hearing what we say in self-abuse reveals our emotional belief. If we say, “I’m stupid”, or “I’m useless”, that shows that we’re concerned with significance. If we say, “No-one loves me”, or “I have no friends”, this shows we’re concerned with acceptance. It’s usually both, but we might tend to say one more than the other.

It’s true that nobody can make us feel bad without our consent. However, by the time we’re mature enough to realise this, a lot of damage can be done — and usually has been. None of us naturally want to think badly of ourselves. Why would we? Firstly, we’re not often aware we do! We take in beliefs about ourselves from our earliest childhood, and they become part of who we think we are. Say we’ve developed a low self-esteem through being told we’re useless or unlovely. One day, decades later, we drop a glass and it shatters. We are so used having anger and ridicule directed at us that, although there’s no-one else around, we’ll insult ourselves, as those who used to abuse us would have done, if they were there. We do this to keep a sense of stability in our life: we’re the scapegoat, this is how life is. When anything goes wrong, we’re to blame. We take the role of persecutor as well as victim, as if to demonstrate that we know where our place is.

We might also develop a low self-esteem when we feel our emotional needs aren’t met. These needs can be either valid (and should be met) or invalid (we expect too much). We’ve previously seen that all people have two valid emotional needs, love and significance. But I think that sometimes, we develop a low self-esteem because we are too egocentric.

Almost all of us have come to expect much from life. We agree with ads that say “You deserve this!” [33] Other examples of advertising tags are: “the most important person in the world is you”; “because you’re worth it”; and finally “you have every right to expect more.” If these companies wanted to destroy human relationships as quickly as possible, they couldn’t have devised better slogans. But I don’t think they create this ideal of self-centredness. We humans naturally seem to believe that we deserve the best, and a lot of it.

Most of our self-esteem comes from what we do. This is why some people die soon after they retire: they can no longer say “I’m a …” When they lose their job, they feel they have lost their identity, purpose and value. If we confuse who we are with what we do or what we have, our self-worth is on unsteady ground.

But what about when we’ve worked hard to achieve a goal, but it doesn’t work out? Is it unfair to feel we’ve been ripped off? I myself have earned two bachelor’s degrees (four and three years of study respectively) as well as completing two courses in writing and editing. I have worked on factory floors and mines, in offices and outdoors. I have edited PhDs, written various articles, and worked as a personal assistant. Yet for about two years I was unemployed, and the highest paid job I have ever had barely earned $30,000. I live in a granny flat, drive a 20-year-old car, and don’t have a landline telephone.

While I studied (reasonably) hard, I didn’t know about studying smart: focussing in depth on several topics. I also started university when a simple bachelor’s degree commanded respect, and could get you a decent job. Those were the days when technical and further education schools were considered a second-class option, only to be chosen if you couldn’t get into university. So I expected a decent job once I completed my degree. It didn’t take too long to disabuse me of this expectation. The degree wasn’t good enough: you also needed experience …

Am I angry that my education has been next to worthless in getting me decent work? When I let myself dwell on it. Has this turn of events contributed to my depression? I doubt it’s helped. Am I capable of doing more? I certainly think so. But even when I do, and have, more, my self-esteem isn’t necessarily higher. Many philosophies teach that we should keep our lives free from the love of anything that can be taken away from us: possessions, our talents and abilities, or even our own bodies. Finally, we don’t have much to depend on at all. So if we can’t depend on what we have or what we do for our self-esteem, what can we depend on? On what basis can we build a healthy self-esteem?

If we can’t rely on ourselves for correct self-esteem, can we rely on other people? In view of what we’ve seen already, you’d think No we can’t. However, much of our self-esteem does depend on what we expect from others.

Religious bit. Self-esteem
People with low self-esteem — and not just with depression — may think “I’m not worthy of God’s love.” They think that other people are, but not them. As I understand both the Bible and logic, this is correct. To be worthy of a thing means we’ve earned it. But we can’t earn love: neither God’s nor anyone else’s. Love is given, not earned. And loving someone doesn’t depend on their response to us. It’s like children and vegetables: kids may accuse us of being mean when we make them eat vegetables. But if we love them, we want them to be healthy: that’s why we make them eat vegetables. That’s the logic.

The Bible says that no human is worthy of (God’s) love. Deuteronomy chapter 9 asserts:

Do not say to yourself, “The LORD has brought me here to take possession of this land because of my righteousness.” … It is not because of your righteousness or your integrity that you are going in to take possession of their land; but on account of the wickedness of these nations, the LORD your God will drive them out before you, to accomplish what he swore to your fathers, to Abraham, Isaac and Jacob. Understand, then, that it is not because of your righteousness that the LORD your God is giving you this good land to possess, for you are a stiff-necked people.

Remember this and never forget how you provoked the LORD your God to anger in the desert. From the day you left Egypt until you arrived here, you have been rebellious against the LORD. At Horeb you aroused the LORD’s wrath so that he was angry enough to destroy you. [34]

Romans 3 states:

What shall we conclude then? Are we any better? Not at all! We have already made the charge that Jews and Gentiles alike are all under sin. As it is written:

There is no one righteous, not even one;
there is no one who understands,
no one who seeks God.
All have turned away,
they have together become worthless;
there is no one who does good,
not even one. [35]

And Titus 3 says that God [36]

saved us, not because of righteous things we had done, but because of his mercy.

Clearly, not one of us is good enough for God. The purpose of the Law of Moses was to show us that we can’t be good enough. Galatians says that “if a law had been given that could impart life, then righteousness would certainly have come by the law.” [37] And again, “if righteousness could be gained through the law, Christ died for nothing!” [38] And again, Romans 3 states that “no one will be declared righteous in his sight by observing the law; rather, through the law we become conscious of sin.” [39]

That’s why God gave the Law of Moses: to show us that we aren’t good enough. We never were, and we never will be — we can never “make it up” to God. This is meant to make us despair of being good enough. This is meant to drive us to God to beg for His forgiveness. Paul continues:

But now a righteousness from God, apart from law, has been made known, to which the Law and the Prophets testify. This righteousness from God comes through faith in Jesus Christ to all who believe.

If we can’t be good enough, we have to rely on God. That’s foundation of what it means to be righteous; to depend wholly on God. This is where our self-esteem should come from:

God demonstrates his own love for us in this: while we were still sinners, Christ died for us. [40]

ii. Expectations
Expectations are beliefs about things should work. In the context of depression, expectations are beliefs about how other people should behave towards us. Our expectations differ depending on our relationship to a person. We don’t expect our local checkout chick to remember our birthday; but we do expect our family to. We don’t expect our work colleagues to give us emotional support; but we do expect our friends to. Like self-esteem, some expectations are valid: parents should take care of their children until they become adult; children should take care of their parents when they become old. In return for our taxes, governments should provide justice and civilisation.

Each of us is vulnerable to the pressure of different expectations. One person may not care about being on time for work; another might be careless about their personal hygiene. A third person may be terribly offended if people don’t RSVP to their invitation; yet another, afraid of social disgrace, might lie to cover a potential embarrassment.

Some expectations may vary with age and culture. Westerners tend to be individualistic and success-oriented. Not to be able to buy a house is failure. This mindset makes us more vulnerable to loneliness and the effects of dog-eat-dog competitiveness. On the other hand, Oriental cultures place a greater emphasis on family, unity and honour. To bring shame on themselves and their family is to fail. Students have been known to commit suicide because they were ashamed of their grades. Shame carries more power in the East than in the West, where sensationalist media make us emotionally numb [41]. But in an Oriental culture the fear of social disgrace makes a person liable to experience depression. In fact, this social pressure contributes to a phenomenon in Japan called hikikomori. The expectation to perform well is such a pressure on young people that some of them withdraw to their rooms — and don’t leave them, sometime for years.

In the section on self-esteem we saw that we naturally think that we deserve the best; or at least better than we’re getting. “I deserve more.” But here’s the rub — deserve more from whom? From other people? God? Maia? Fate, destiny, or karma? Whichever we believe, how can we get it from them? Simply, we can’t. We have to rely on their goodwill and their constancy.

It’s natural for us to want a pleasant life; but as our standard of life has become higher, so have our expectations. We expect household machines to be faster and quieter, personal service to be better, and our partners to be cuter and more sensitive to our needs. Advertising takes hold of that desire and plays on it, implying that we won’t be happy until we have what they’re marketing. We fall for these lies: we come to believe that we deserve whatever we can get. Even if our lives are mostly pleasant, there’s always some way they fail to be. Eventually, our expectations won’t be met. So to avoid the reality that we can’t always get what we want, we develop ways of comforting ourselves: food, sex, clothes, sport, work … you know the list.

But at some stage, our comforts and coping mechanisms won’t work; they won’t fill the void within us. Then we’re back to square one: dealing with the disappointment of failed expectations. How we react depends on whether we believe we can do anything about it. If we think we can, the cycle — void; answer; failure; void answer; failure — begins again. But if we don’t think we can, our disappointment will hit us with its full force. We’ll feel frustrated, resentful, angry. And perhaps we develop depression. We have to accept the fact that life isn’t fair; that sometimes we don’t get what we want — or even what we need. This is an unpleasant, deplorable fact; but such is life.

Conclusion
Other people let us down. We can’t rely on what we do or have. So the question remains: How can we have a correct self-esteem? Essentially what we believe about ourselves depends on our beliefs about life, the universe and everything. Is there meaning outside ourselves? If there is, how far are we from finding and living out that meaning?

Religious bit. God and Suffering
Never will I leave you; never will I forsake you.
~ God, Hebrews 13:5

It’s ironic that when life goes wrong, the response of many people is to blame God, whatever their conception of the divine might be. However, when things are fine and dandy, do we thank God for it? Some have asked, how can a loving God send people to hell? This is based on two false premises: (1) that we don’t deserve Hell; and (2) that God sends us there. In contrast, the first verses of Ephesians chapter two say that we’re born citizens of Satan’s kingdom. Like gives birth to like, sinful parents give birth to sinful children. We aren’t born morally neutral. As King David said, “Surely I was sinful at birth, sinful from the time my mother conceived me.” [42] The only exception to this law of nature is Jesus.

So what about God being love? The Bible says He is, in 1 John 4:8 and 16. But what is love? A warm-gooey-fuzzy feeling that makes you feel you’re walking on air? Love isn’t a feeling: it is a commitment to someone else. It is a decision to do the best for them. Jesus illustrated this when He said “Greater love has no one than this, that he lay down his life for His friends.” [43] Later, in the garden of Gethsemane, we see part of the struggle and emotional strain this was on Jesus. Though He knew there was no other way to save us, He still prayed that if there was, to take that way. In Matthew’s Gospel, Jesus prayed this prayer three times: surely that gives some sense of His struggle! [44] But each time, He chose to obey the Father’s will. That is love, not a casual sloughing off of a minor problem like a house burned to the ground. “Oh it doesn’t matter: I’m okay, you’re okay.”

So much for a God of mild, milquetoast fluffy feelings but no sacrifice. And as for a God of only love, isn’t justice the other pillar of a balanced emotional world? But no one asks: why should a just God be merciful to people who are born rebels, and who reject Him? Why should such a God give anything good to people whose natural attitude is “I am the master of my fate; I am the captain of my soul”? Why should He tolerate people who treat His world as though it belongs to them? Why should Aslan tolerate the white witch Jadis usurping his rule? m[45] He won’t; not forever. But God is patient, not wanting people to be destroyed, but to turn to Him and be saved.

Suffering is where theology and anthropology meet. Correct doctrine is cold comfort, though. We don’t want answers: we want others. Pain is agonising enough — it can be excruciating — but to be alone in our pain is to suffer.

During these times, or when life merely falls short of our expectations, hold on to the promises in the Bible; for example:

Never will I leave you;
never will I forsake you.
(Hebrews 13:5)

One thing God has spoken,
two things have I heard:
that you, O God, are strong,
and that you, O Lord, are loving.
(Psalm 62:11-12)

He who began a good work in you will carry it on to completion until the day of Christ Jesus.
(Philippians 1:6)

My sheep listen to my voice; I know them, and they follow me. I give them eternal life, and they shall never perish; no one can snatch them out of my hand. My Father, who has given them to me, is greater than all; no one can snatch them out of my Father’s hand.
(John 10:27-29)

In all things God works for the good [NB not “the temporary happiness”] of those who love him, who have been called according to his purpose.” [46] (Romans 8:28)

Finally remember that in Christ, God has suffered:

The other gods were strong, but You were weak;
they rode, but you stumbled to a throne.
But to our wounds only God’s wounds can speak;
and not a god has wounds, but You alone. [47]

b. What we focus on
This is the second aspect of the mental causes of depression. What we focus on determines where we go. Learning to drive, I was told that where our eyes look, our body goes. Always look up at where you want to go, not where you’re afraid you’ll end up. This is especially so when riding a bicycle. If you look over your shoulder, the bike will turn slightly in that direction. Try doing a figure-eight. As you’re turning, if you look down, you’re more likely to get closer to the ground. You may not fall off, but your turn will be wider and more uneven than it is if you keep your head up and look at where you want to go.

In the same way, where we direct our thoughts is where our mind will go. If all we can see is bad things, that’s the track our mind will follow. When we are told we’re useless or stupid often enough, these become fixed points in our lives. When we need something to focus on, it’s easy, almost natural, for us to lock onto those points. We need something to focus on when we need to interpret an experience in our lives. For example, why did that girl refuse to go out with us? Because we’re ugly. Why didn’t we get that job? Because we’re stupid. It’s easy to fix on these beliefs, rather than consider any other possibility. And it fits with the rest of our life of failure.

4. Lifestyle
These factors may not cause depression by themselves, but they will affect whether it gets better or worse, by affecting how we feel.

a. Diet
You may wake up on the wrong side of the bed because of the prawn laksa you had last night. Lugwig Feuerbach coined the phrase “you are what you eat.” He was partly correct: what we put into our bodies will have an effect on us. If we don’t eat healthfully for a few days, we’ll start to feel, maybe not sick, but just a little “off”: tired, slow, and irritable, with a mild ache or discomfort that we can’t quite pin down.

There are particular foods which give depression the upper hand. If we eat too much sugar, we’ll experience emotional highs and lows. When we’re feeling tired, we eat sugary foods to give us an instant energy boost. But before long the effect wears off, and we feel tired again. If our diet is low in protein, we may miss out on the amino acid tryptophan, which is used to manufacture serotonin [48]. And alcohol, especially red wine, can make depression worse; as can caffeine. However, the side-effect of my medication is tiredness: I find that coffee helps to keep me awake — though I’ve heard that apples do that more effectively — without making my depression worse.

Repeatedly, diet for depression research has found that insufficient consumption of polyunsaturated fatty acids, antioxidant vitamins, folate, and vitamin B-12 is associated with depression. [49]

The site also states that

the problem of insufficent nutrition is compounded by toxins, pollution, free-radicals, and modern agricultural practices. [50]

The only way to deal with the problem of diet is to eat healthfully, perhaps with the help of a doctor or nutritionist. The website http://www.nutritional-healing.com.au has a wealth of information on this topic. In Appendix A there is a table that indicates how depression can result from an imbalance of various nutrients.

Exercise
Before we had so many labour-saving devices, people were more physically active. Just about every activity was more physically taxing than it is today: washing, cooking, ironing, travelling … and we used to sit down to relax. Now, we sit down to work and exercise to relax. It’s ironic, but true: if we haven’t exercised for several days, we’ll feel tired and listless.

Work
As we spend about one-third of our life working (this includes study), what we do plays an important role in our well-being. We are liable to have emotional problems for two reasons: our work seems pointless and we want something more meaningful; or on the other hand, when our work affects others in a direct and powerful way, such as with their health or their money.

Society
There are more people living on Earth today (from the 20th century onwards) than there were in all other centuries combined. Those who live in cities live closer together, in units and apartments; an arrangement that begs a comparison with battery hens. We tend to see other people as objects and obstructions to be navigated around, rather than as part of our community. A community used to be the people within the (one) area where everyone lived and worked, whether they liked each other or not. Today, our communities are diverse: work, sport, family, friends … but our neighbours? We don’t really think of them as part of our community, because with fast and relatively cheap transport, we don’t have to stay in the one place. It is easier to spend time only with the people we want to, and avoid everyone else.

These personal, selected communities become more insular because much of our daily communication is in electronic form, like banking. Where now we go to an ATM or pay through EFTPOS or over the phone, we’d once have to go to a bank and actually speak to another human to withdraw or deposit money. Where once we’d organise by letter or (landline) telephone to meet friends, and spend several hours chatting face to face, we can now have whole conversations where we never open our mouths; where we use only our thumbs and a bastard English (e-glish).

This abundance of sterile communication — sharing only propositions, not our thoughts and emotions — starves us of relationship. We are surrounded with more people and more information than we can cope with; so, emotionally and physically, we withdraw from the bombardment. We start to relate to one another on a “superficial” level, by words only: we deal only with what a person says, but we don’t enter their inner life. This superficiality means we can cope with people’s outward or physical wants without ourselves having an emotional breakdown. (This is why emotional therapists, psychologists and psychiatrists need to keep a detachment from their clients.) When all we deal with is this social noise (all information and no relating), when we have no close friendships, we are fertilising our lives for the seeds of depression.
[1] What’s Good for You.
[2] “Description.”
[3] “Pineal gland.”
[4] Schwarz, Theodore B. “Endocrine system, human.”
[5] “Melatonin.”
[6] Hebrews 12:5-11. The word translated “punishes” means to beat severely: it can also be interpreted as “discipline”. It was what Jesus warned His disciples to expect (Matt. 10:17), and what Jesus Himself experienced (Matt. 20:19) (“Mastigoō”): but this was from the worldly authorities, not as punishment from God. Still, the writer has just said, “In your struggle against sin, you have not yet resisted to the point of shedding your blood” (verse 4). If this can’t be called taking a severe beating for holiness, I don’t know what can.
[7] Discounting the supernatural results from the assumption that the majority of human experience is always correct, and anything that contradicts it must therefore be wrong.
[8] Shariah is a particular interpretation of the Muslim holy writings.
[9] This belief is based on Genesis 9:22-27. But the text actually reads that Canaan was cursed; not Ham. Canaan was Ham’s youngest son, and his descendents, the Canaanites, lived in Palestine, not in Africa.
[10] “Condition > Depression.”
Serotonin and noradrenaline are the final products of chemical processes that involve several other amino acids and neurotransmitters such as phenylalanine and dopamine. A simplified version of the processes from the http://www.nutritional-healing.com.au website is shown in Appendix A. Our brain is the primary source and scene of the chemical reactions that affect our minds; other publications might call it “neurochemistry”.
[11] In the United States, noradrenaline is called norepinephrine.
[12] ”Suicide and Depression.”
[13] If we don’t have the Short Serotonin Transporter Gene, we have a Long STG (news.com.au). The news article didn’t give the amount of people the studies used, but assuming it’s a reliable study, we can take the number (43%) as accurate.
[14] This is called the “nature/ nurture debate”.
[15] Such as the philosophy of David Hume and the psychology of B.F. Skinner.
[16] Galen’s grouping was based on Hippocrates’ earlier identification of the four humours. “Humour” in this context refers to attitude. Galen thought that four types of bodily fluid (black bile, phlegm, yellow bile, and blood) affected our attitudes. “Galen of Pergamum”, EB.
[17] This Hulk was a TV series in the mid-1980s.
[18] Is it any wonder that teenagers don’t listen to what their parents say?! Children learn very quickly, and this lesson is that of dog-eat-dog: dominate who you can, but submit to those you can’t. Whatever you have to do to get your own way, do it.
[19] Possibly what our parents are reacting against is not our action (standing up for ourselves), but our attitude, which is probably defiant, angry and sulky. It’s not just what you do, it’s the way that you do it.
[20] I learned of these two essential needs from Dr Larry Crabb’s book Inside Out.
[21] Dr. James Dobson. Man to Man about Women.
[22] Some jobs get more money and respect, not necessarily earn it.
[23] Despite tales like the Babylonian Epic of Gilgamesh.
[24] A Book of English Poetry, p.311.
[25] The World’s Greatest Mistakes, pp.182-191.
[26] In terms of Freudian psychology, our id is unable to vent its anger, so it stomps off in a childish sulk.
[27] Dr. James Dobson, Focus on the Family radio program.
[28] A complex issue, but essentially I had a wrong view of God. And I know that this might belong in the religious bit: if you don’t like it, write your own book on depression!
[29] I think that “right” refers to the victor’s authority, not that they define morality.
[30] Hopelessness is one of the emotional symptoms of depression.
[31] When all the energy in the universe has been used up, what will happen? Extinction? Or will the universe recoil to another Big Bang, and rebound to form another universe? If so, could humanity survive into that new universe (and the others that would potentially follow)?
[32] See the list of mental symptoms in chapter two.
[33] If you deserve something, why do people want you to pay for it?
[34] Deuteronomy 9:4-8
[35] Romans 3:9-12. This (and up to verse 18) is a group of several Old Testament verses drawn together to make a point. Such a group is called a catena or a florilegium.
[36] Titus 3:5
[37] Galatians 3:21
[38] Galatians 2:21
[39] Romans 3:20
[40] Romans 5:8
[41] Look at magazines at the supermarket checkout. See how many times you can see words like “amazing”, “shock”, “scandal” and the like: all words used to elicit an emotional reaction.
[42] Psalm 51:5. This will bring up the question about why Jesus had to die. The answer isn’t in the purview of this book, but there are many other books that deal with the question.
[43] John 15:13
[44] Matthew 26:39-44
[45] The Chronicles of Narnia: the lion, the witch and the wardrobe. The “captain” quote is from the poem Invictus by William Ernest Henley.
[46] This implies that we believe what God has said about Himself. It doesn’t mean that if you love a false image of God, believing it to be the true one, that we are saved. That is, if Christianity is true, you can’t be an atheist or a Hindu, et cetera, and be saved.
[47] This poem is by Edward Shillito.
[48] “The Diet And Depression Link – Diet For Depression.”; “Tryptophan.”
[49] “The Diet And Depression Link – Diet For Depression.”
[50] “The Diet And Depression Link – Diet For Depression.”